Whitney Houston Autopsy Reveals Heart Disease
The death of Whitney Houston in some ways represents a medical “perfect storm” - heart disease and a plethora of drugs that can accelerate or aggravate that condition, cardiovascular specialists told MedPage Today.
“A lot of people were surprised that Whitney Houston - according to the coroner’s report - had cardiovascular disease, but that was not surprising to me, because we knew she had a least one major risk factor for heart disease, cigarette smoking,” said John Gordon Harold, MD, the president-elect of the American College of Cardiology.
Harold, clinical professor of medicine at Cedars-Sinai Heart Institute, Los Angeles, and other cardiologists contacted by MedPage Today said there were several scenarios that could explain how Houston drowned in her hotel bathtub February 11.
- The ‘hot tub syndrome’ - sedative drugs found in Houston’s system might have caused her to fall unconscious and slide under the water. “We see this often in people who have been partying and have sedatives on board,” Harold said.
- Cocaine also reported in her body could have caused vasospasm or arrhythmia that caused her to lose consciousness and drown.
- With some coronary arteries substantially blocked, a drug-induced spasm could have closed a diseased artery enough to occlude blood flow, causing a heart attack that caused her to drown.
Whatever the triggering event, the fact that Houston was alone and in a bathtub when she suffered a critical event, prevented timely resuscitation and emergency assistance, and turned the incident into a fatality.
Cocaine and the heart
Acute myocardial infarction (AMI) is the most commonly reported cardiac consequence of cocaine misuse, but significant arrhythmias are also reported. More than 100 case reports of cocaine-induced AMI have been published since the early 1980s.
There are a number of proposed mechanisms of cocaine-induced myocardial infarction. Firstly, in-vitro studies have shown that cocaine activates platelets, increases platelet aggregation and potentiates platelet thromboxane production.
Secondly, the sympathomimetic effects of cocaine induce an increase in heart rate and blood pressure, leading to a resultant increase in oxygen demand by the heart. Cocaine could lead to myocardial ischaemia and subsequent infarction, particularly in the presence of underlying coronary artery disease.
Thirdly, coronary artery vasospasm has been suggested as another mechanism for cocaine-induced AMI. The mechanism by which cocaine may induce vasospasm is not understood. There are two schools of thought suggesting a wide role for cocaine as a general vasoconstrictor, and another suggesting a more specific role for cocaine on the vascular smooth muscle leading to vasoconstriction. Of particular note is a study showing the possible role of endothelin-1, the most potent endogenous, endothelium-derived vasoconstrictor factor. That study showed a significantly increased concentration of endothelin-1 in actively intoxicated and chronic users of cocaine over healthy control subjects. However, it was difficult to determine whether this increase alone was sufficient to induce coronary vasospasm. The study went on to hypothesise that, because endothelin-1 increases the calcium sensitivity of arteries, it may sensitise the vasculature to other vasoconstrictor stimuli and prolong coronary vasoconstriction or vasospasm, causing acute myocardial infarction even in people without coronary stenosis.
In addition to finding blockages in Houston’s coronary arteries, the Los Angeles County coroner said that toxicology tests indicated Houston was a chronic user of cocaine. He also reported that marijuana, the muscle relaxant Flexeril, the allergy medication Benadryl, and the anti-anxiety medication Xanax were found in her system. Fresh water was found in her lungs, indicating that the immediate cause of death was drowning, according to the autopsy report.
Houston’s lifestyle also likely impacted development of cardiovascular disease, said several doctors interviewed by MedPage Today. None of those physicians treated the singer and actress who died at age 48.
“I think the take home message for young African American women is that they are not immune to heart disease, and smoking is a major risk factor,” said Harold. “What we often see in women like Whitney Houston is unrecognized or undiagnosed high blood pressure and hyperlipidemia - the same risk factors that we see in men.”
“I was one of her fans,” admitted Harold, who said that Houston long-time smoking habit, her use of marijuana and cocaine all would have had increased the risk of cardiovascular disease.
“Smoking was her major risk factor for coronary artery disease,” Harold said. “Marijuana smoking is known to increase the risk of heart disease. Acute administration of cocaine causes blood vessel constriction even in people with normal blood vessels. You can have cocaine-induced stroke or myocardial infarction.
Smoking the major risk factor for coronary heart disease
Smoking accounts for about more than a half million premature annual deaths world wide. Smoking is a leading and one of the most preventable risk factor for coronary heart disease (CHD).Smoking doubles the risk for CHD and sudden cardiac death. In Nepal there is evidence that among the patients with myocardial infarction and acute coronary syndrome more than 80% were smokers. The female smoking rate is highest in Nepal than any other part of the world accounting for 73% in the hilly region. WHO statistic’s reveals that the prevalence of smoking in Nepal among the age group varying from 15 to 30 is more than 70%.We have made one randomized study among the patients attending the out patient clinic of our Shiva hospital. Age of the patients studied varied from 35 to 75 years, we did analyzed 200 people, 78 male (39%) and 122 female (61%).Our data shows the prevalence of smoking in female is 50 %( 61 out of122) and the prevalence of smoking in male is 46.15 %( 36 out of 78). The growing smoking rate in teens, the high smoking rate in females and males and the effect of passive smoking has definitely become a major problem in our country. Smoking in teens may accelerate the atherosclerotic process in adolescents thereby, making themselves more fertile to be hunted by CHD in their near adulthood.
“In fact, in young people who present with stroke or a myocardial infarction with no other cause, we almost always order a blood screen for possible illicit drugs, because it is a known risk,” he said.
“We understand that with Whitney Houston there was chronic cocaine use,” said Joanne Foody, MD, associate professor of medicine at Harvard Medical School and director of the Cardiovascular Wellness Center at Brigham & Women’s Hospital, Boston.